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A picture soon may be worth more than a thousand words to those who suffer chronic low-back pain. Researchers at Brigham and Women's Hospital, using arterial spin labeling, a new imaging technique, have been able to follow the changes in brain activity that occur when chronic low-back pain worsens. The research, published in the August 2011 issue of Anesthesiology, may one day provide physicians with a much-needed objective measure of pain progression among those who endure chronic discomfort.

"This study provides tools to objectively describe a subjective experience, that of chronic pain," says lead author Ajay Wasan, an HMS assistant professor of psychiatry at the Pain Management Center at Brigham and Women's. "When a patient's pain worsens, we found there are changes in activity in the areas of the brain that process pain and mood."

Working with 16 patients with chronic low-back pain and 16 healthy volunteers, researchers determined participants' pain baselines, had them perform clinical maneuvers such as pelvic tilts to exacerbate pain, then applied heat to their skin to match the pain experienced during movement. During the movement and heat sessions, researchers used arterial spin labeling imaging, which allowed them to quantify the blood flow, and, thus, neuronal activity, to specific regions of the brain over time.

They found that, for those suffering from chronic pain, brain activity increased in response to the pain-spiking movements but not to the heat-induced pain. Healthy participants showed no activity increases. The researchers hope the work will lead to a better understanding of neurocircuitry at the individual level and, ultimately, the development of personalized therapies.